Provider Demographics
NPI:1982317160
Name:GARDNER, CALEESHA TIARA (FNP)
Entity Type:Individual
Prefix:
First Name:CALEESHA
Middle Name:TIARA
Last Name:GARDNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 GENERAL PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6225
Mailing Address - Country:US
Mailing Address - Phone:504-881-1452
Mailing Address - Fax:
Practice Address - Street 1:2701 GENERAL PERSHING ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6225
Practice Address - Country:US
Practice Address - Phone:504-881-1452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA228292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily